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A bill building off Gov. Ron DeSantis’ call to import prescription drugs from Canada cleared its first committee stop Tuesday, amid ongoing concerns from some lawmakers about how a potential program would be structured and how much it might save Floridians and the state.

The House Health Quality subcommittee voted 12-2 to advance HB 19, which would direct the state Agency for Health Care Administration, via a vendor, to establish a list of drugs and Canadian suppliers that might yield savings for the state. The bill also proposes a similar “international” program that would allow private citizens to import drugs from other countries aside from Canada by permitting wholesale drug distributors and pharmacies abroad to export medication to similar drug distributors, pharmacies and pharmacists registered with the state.

Under a 2003 federal law, the proposal would need the approval of the federal Department of Health and Human Services to take effect. Past federal Health and Human Services secretaries, including current Secretary Alex Azar, have declined to do so.

Rep. Tom Leek, R-Ormond Beach, who is sponsoring the bill, told committee lawmakers the proposal would shift cost savings to consumers, citing the high cost of prescription drugs nationwide.

“We’ve allowed the government to create a regulatory scheme so complex and so convoluted that we’ve stacked the deck against the consumer and put profits over patients,” he said. “Today, you — we — have the chance to win one for the consumer.”

He acknowledged in response to some lawmakers’ questions that there were no specific price controls built into the bill, but “what’s built into this bill is the free market… It’s a simple economics philosophy that we know will work here.”

Canada imposes restrictions on how much pharmaceutical companies are allowed to charge for medicines — the U.S. does not. Though it is technically illegal to import prescriptions from Canada, many Americans currently do so, including some entities in Florida.

Allowing the importation of prescription drugs from America’s northern neighbor has also been floated by a number of other politicians, most notably presidential candidate and U.S. Sen. Bernie Sanders of Vermont. Last year, Vermont was the first state to pass a bill that would have allowed prescription drugs to be imported from Canada, though it has not obtained the federal approval required for implementation.

When DeSantis proposed allowing drug importation from Canada last month, he acknowledged that the federal government had never granted such approval to a state. But the governor said at the time that he had spoken to President Donald Trump about ensuring that approval, and that he was “not only supportive, he’s enthusiastic.”

The White House subsequently released a statement suggesting that it was still reviewing the details of the proposal, and that the administration “looks forward to educating Governor DeSantis on the many policy options [it] has proposed to reduce costly drug prices for American families.”

Supporters of such proposals say it could save millions in rising drug costs in the country, and DeSantis has projected similarly significant savings for the state. But others have raised concerns about how prescriptions in the supply chain would be deemed safe and how other countries, insurers or pharmaceutical companies might react to such importation programs.

In Tuesday’s hearing, some pharmacists and pharmaceutical officials questioned the proposal and how effectively and how safely it would address what they agreed was a rapid rise in prescription drug costs.

“What kind of reasoning are we giving to patients?” asked Vikram Rao, a pharmacist who leads the Florida Independent Pharmacy Association. Noting the government has previously barred importing drugs from abroad, he said patients might question “why have you been telling me all these years that we cannot buy drugs from Canada?”

He and other pharmacists pressed the committee to address pharmacy benefit managers, which Rao said contribute to the marking up of prescription drugs in the state.

John Clark, a vice president and chief security officer for Pfizer, also raised concerns about the potential for counterfeit drugs, saying the pharmaceutical company had seen an increase in in its own drugs being copied over the years.

Some lawmakers, including Rep. Rene Plasencia, R-Orlando, also asked about potential unintended consequences of the bill, raising issues like whether Canada’s existing supply of pharmaceuticals might accommodate Florida’s population of 20 million. Others questioned whether insurance companies or pharmacy benefit managers might move to reject covering prescriptions that are imported from other countries, nodding to the second, broader portion of the bill.

Leek acknowledged repeatedly that “there are no guarantees” of the bill’s specific impact, but said “expanding the footprint of the market” would likely reduce prices by increasing supply to meet demand.

Rep. Carlos Guillermo Smith, D-Orlando, said he was pleasantly “stunned” to hear the potential for importation raised in a House committee, though he pressed Leek on why the state might not also consider Medicaid rebates or price controls similar to Canada’s to also reduce prescription drug costs. He also highlighted concerns he had about preventing a potential state vendor from having conflicts of interest with drug manufacturers, noting the state “does not have a great track record” in selecting such entities.

“Can we make sure the state of Florida doesn’t hire a total bozo to run this program?” he asked after the meeting.

The proposal — as a priority of the governor and Speaker José Oliva, R-Miami Lakes — is likely to coast through the House. But to reach federal officials, it must also clear the Senate, where the bill's companion faces a tougher field. SB 1528, the Senate bill that is moving through the chamber, only includes the Canadian portion of the proposal.

That mirrors concerns raised by Senate President Bill Galvano, R-Bradenton, who told reporters last month that the governor’s plan to allow the state to import drugs from Canada was something he was “interested in exploring,” but that he worried the portion that would allow individuals or private entities to receive imported drugs from abroad might run afoul of Congress’ jurisdiction.